Meeting Information

Department of Health and Human ServicesPublic Health Service | National Institutes of HealthJohn E. Fogarty International Center for Advanced Study in the Health SciencesSeventy-fourth Meeting of the Advisory Board Minutes of MeetingMay 26, 2011

May 26, 2011 The John E. Fogarty International center for Advanced Study in the Health Sciences (FIC) convened the seventy-seventh meeting of its Advisory Board on Monday, May 26, 2011 at 9:00 a.m., in the Conference Room of the Lawton Chiles International House, National Institutes of Health (NIH), Bethesda, Maryland. The closed session was held on February 7 from XXXXXXXX, as provided in Sections 552(b)(4) and 552(b)(6), Title 5, U.S. Code, and Section 10(d) of Public Law 92-463, for the review, discussion and evaluation of grant applications and related information. The meeting was open to the public on May 26, 2011 at 9:00 a.m., until adjournment at 2:50 p.m. Dr. Roger I. Glass, Director, FIC, presided. The Board roster is appended as Attachment 1.

Attendee Information

Board Members Present:

Dr. Roger Glass, Chair

Dr. Robert A. Black

Dr. Gail H. Cassell

Dr. Maria Friere

Dr. Adel Mahmoud

Dr. Ariel Pablos-Mendez

Dr. Bonita Stanton

Dr. Sten Vermund

Dr. Derak Yach

Dr. Alan Guttmacher, NICHD/NIH (ex officio)

Dr. Susan Shurin (ex officio)

Board Members Absent:

Dr. Peter Hotez

Dr. Roscoe Moore

Dr. Arthur Reingold

Dr. Kevin M. DeCock (ex officio)

Dr. Donald Lindberg (ex officio)

Members of the Public Present:

Dr. Scott Campbell, Executive Director and CEO, Foundation for the National Institutes of Health, Bethesda, MD

Ann Lurie, Foundation for the National Institutes of Health, Bethesda, MD

Jenna Mills, Foundation for the National Institutes of Health, Bethesda, MD

Dr. Elaine Gallin (affiliation? QE Plulanth Advisors)

Dr. Patrick Kelley, Institute of Medicine, Washington, DC

Mr. Aaron Sherinian, United Nations Foundation

Dr. Mary Wooley, Research America

Federal Employees Present:

Ms. Farah Bader, FIC/NIH

Ms. Danielle Bielenstein, FIC/NIH

Ms. Katrina Blair, FIC/NIH

Dr. Barry Bloom, FIC

Dr. Joel Bremen, FIC/NIH

Dr. Kenneth Bridbord, FIC/NIH

Dr. John Burklow, NIH

Mr. Bruce Butram, FIC/NIH

Dr. Lois Cohen, NIDCR/NIH

Dr. Dexter Collins, FIC/NIH

Lena Diaw, NHLBI/NIH

Rene Etchebarrigaray, CSR/NIH

Mr. Robert Eiss, FIC/NIH

Dr. Dan Gernnedsay, CSR/NIH

Dr. Steve Goldstein, FIC/NIH

Lisa Gough, NCRR/NIH

Mr. Jeffrey Gray, FIC/NIH

Gray Handler, NIAID/NIH

Dr. James Herrington, FIC/NIH

Dr. Karen Hoffman, FIC/NIH

Dr. Michael Johnson, FIC/NIH

Dr. Christine Jessup, FIC/NIH

Robert Kaplan, OBSSK/NIH

Dennis Lang, FIC/NIH

Ms. Judy Levin, FIC/NIH

Dr. Maya Levintova, FIC/NIH

Dr. Edith Light, NIMH/FIC

Dr. Jeanne McDermot, FIC/NIH

Dr. Kathleen Michels, FIC/NIH

Dr. Mark Miller, FIC/NIH

Dr. Yvonne Njage. FIC/NIH

Dr. Ann Puderbaugh, FIC/NIH

Dr. Myat Htoo Razak, FIC/ NIH

Dr. Letetia Robinson, FIC/NIH

Dr. Susan Shurin, NHLBI/NIH

Barbara Sina, FIC/NIH

Branka Sekis, SSS

Dr. Hillary Sigmon, FIC/NIH

Rachel Sturk, FIC/NIH

Ms. Kristen Weymouth, FIC/NIH

Ms. Celia Wolfman, FIC/NIH

Contractor Present:

Mr. Sean Jeffrey, FIC/NIH

Closed Session

Open Session

Director’s Update and Discussion of Current and Planned FIC Activities

Welcoming Remarks

Dr. Glass called the meeting to order and welcomed those present. He commented that, in addition to being Fogarty International Center Director, he was Associate Director of International Research at NIH. He welcomed new Board member Dr. Adel Mamoud, currently a professor at Princeton University. Dr. Glass also welcomed Dr. Barry Bloom, Dean of the Harvard University School of Public Health; and Dr. Ann Lurie, who has been involved in global health initiatives in Africa especially related to children’s health; and Dr. Patrick Kelley from the Institute of Medicine.

In recognition of distinguished accomplishments, Dr. Glass noted that Board member Dr. Robert Black had been awarded the 2011 Canada Gairdner Global Health Award, and Dr. Maria Freire, also a Board member, was involved in developing the latest cohort of mid-level Fellows of the Lasker Clinical Research Scholars Program at NIH.

Transitions

Since the last meeting a number of transitions have taken place. Dr. Glass noted that Dr. Karen Hofman, Director, Division of Science Policy, Planning and Evaluation (DISPPE) for ten years, was returning to Africa to continue her contributions to science there. Dr. Michael Johnson, FIC’s Deputy Director, is leaving to join the Office of the Global AIDS Coordinator to serve as Global Fund Attaché in Geneva.

On the Board as ex officio members, Dr. Glass announced the departure of Dr. Barbara Alving and the arrival on the board for Drs. Susan Shurin and Alan Guttmacher. He added that Dr. Alving would be moving to the National Center for Advancing Translational Science (NCATS), which would subsume her present center, the National Center for Research Resources (NCRR), where she is director.

Overview of Fogarty International Center Operations and Activities

FIC STRATEGIC PLAN. Dr. Glass explained that early in his tenure at Fogarty a five-year strategic plan was developed. The plan included five provisions: 1) to encourage the scientific community to address the changing the focus of the burden of disease to include non-communicable diseases as well as the then dominant HIV-AIDS epidemic; 2) to affirm that implementation through implementation science was a priority; 3) to enhance the development of human capital in the global health area (Fogarty’s main contribution is to provide training opportunities); 4) to foster a sustainable research environment in low- and middle-income countries, mainly through grants; and 5) to build strategic alliances and partnerships in global health.

ACTIVITIES SINCE LAST BOARD MEETING. During the past five years a number of activities have supported the strategic plan. Young scientists have been encouraged to visit NIH to learn more about the NIH role in international health. The Barmes Lecture was established, with Barry Bloom as the first lecturer. Fogarty has supported the efforts of USAID, under Raj Shah’s leadership, to integrate global health activities across the federal government. Fogarty sponsored notable speakers, like the United Kingdom’s Nigel Crisp, whose lecture included the following advice: allow greater self-determination by developing countries, especially to support the education and training of health workers within their own borders.

Dr. Glass noted the important support of the NIH Director, Dr. Francis Collins, who has made international health a high priority for NIH. Among other activities, Dr. Collins accompanied a Fogarty mission to China in October 2010 to look at issues related to the high incidence of stroke there, and to South Africa in March 2011 to launch H3 Africa, a program on heredity and human health in Africa. Shortly after that, also in South Africa, he participated in the launch of the MEPI, the Medical Education Partnership Initiative. MEPI is a collaboration of most of the NIH institutes, CDC, USAID, USDoD and others to support local training in Africa in the area of infectious diseases. That first MEPI meeting was attended by the deans of more than 30 African medical schools. Dr. Collins also visited the CAPRISA program (Center for the AIDS Program of Research in South Africa), which was involved in an important microbicides trial for prevention of HIV infection.

Dr. Glass commented that he and several Board members visited Russia in an effort to promote greater collaboration. The Foundation for NIH was especially supportive in terms of funding for that visit. It is hoped that there will be a series of meetings, either face-to-face or by teleconference, with U.S. and Russian scientists to explore possible opportunities for joint ventures. A firm commitment came out of the visit – a bilateral agreement to hold a U.S. Russia Scientific Forum on Biomedical and Behavioral Research in November.

In other activities, Dr. Glass mentioned Fogarty support of a Global Health Initiative program on women’s and girl’s health in the form of 20 grants of $50,000 each to be awarded to researchers in four NIH institutes (NICHD, NIMH, NIAID and Fogarty International). There was also a meeting in early May, attended by Dr. Collins, on indoor air pollution, caused mainly by 3 billion people who rely on indoor cook stoves for cooking and heating. Dr. Glass indicated that significant research was needed to establish the actual risks related to indoor air pollution, identifying the potential benefits of reducing pollution created by indoor cook stoves, and the challenges of changing behavior when individuals are asked to upgrade their traditional stoves or eliminate them entirely.

Dr. Glass commented that the Scholars and Fellows Program, which was at risk of falling into disrepair, was rejuvenated through the efforts of Myatt Htoo Razak. The specialties represented in the program have expanded to include mental health, diabetes, cardiology, ophthalmology, addiction, cancer and infectious diseases. For the first time five Fellows have been added under the new Fogarty-Fulbright Program, which has been helpful in adding funding to the program. The U.S. State Department has also supported three grants for research in Pakistan – two from Fogarty and one from NICHD).

Turning to planned activities, Dr. Glass noted that the Global Health Council would hold a conference on June 13-17 on the growing burden of non-communicable diseases. Fogarty has supported these programs for the past five year, most of that time the only federal agency providing such support. In collaboration with the Foundation for the NIH, on June 20-24 in San Diego, there will be a conference on mobile health and it applicability in the developing world. Early on Fogarty pointed to the importance of implementation, and over the last few years the concept has caught on across NIH. On August 1-5, in Chapel Hill, North Carolina, there will be Training Institute for Dissemination and Implementation of Research in Health.

Finally, Dr. Glass commented that, when he first arrived, there was no centralized data resource to describe the total NIH effort in global research. Nonetheless Fogarty undertook a project to assemble that data for a specific period (2004-2005). At the time there was no way to automatically update the data from year to year. Recognizing the importance of the data, Dr. Collins established the Global Health Working Group and subsequently responded to a proposal from that working group to develop such an automated system. Dr. Collins recently provided $1.2 million from the Director’s Discretionary Fund, and that system will be developed in the next several months. In consonance with that project, Fogarty sponsored an effort to collect data about activities in Africa, research sites, existing grants, principal investigators and so on. Information was gathered from the main actors in the area – Pasteur, EDCTP, CIHR/GHRI sites, Wellcome Trust and NIH grants and collaborations. The data will be available for the next Heads of International Research Organizations (HIRO) meeting in June.

Finally, Dr. Glass commented on the Consortium of Universities for Global Health, established by Dr. Collins three years ago, to enhance the constituency base for NIH ICs. The participating universities have global health programs which have become very popular with the students. Attendance at the first Consortium meeting was about 300, then 800 at the second meeting.

Dr. Glass reiterated the importance of maintaining support for the global health research agenda, and enduring that it includes training and capacity building at all levels. He expressed appreciation for the Fogarty team that has contributed to the success of the many Fogarty programs.

The Interaction of Malnutrition and Enteric Infections: Consequences for Child Health and Development Dr. Mark Miller, Director, Division of International Epidemiology and Populations Studies

Noting that his division included computational biology, malaria modeling, zoonotic and vaccine-preventable diseases, the research and policy for infectious disease dynamics system (RAPIDD), and the U.S.-Pakistan S&T Project, Dr. Miller commented that he would focus his remarks on the Global Network for the Study of Malnutrition and Enteric Diseases, MAL-ED. This partnership, with funding of about $55 million, is managed/coordinated by the Foundation for the NIH.

Dr. Miller noted that, in developing countries, mortality in children under five is related to malnutrition in over half of the reported deaths, and directly attributable to diarrhea in 15% of reported deaths, although there is little information on the cause of the diarrhea. Nor is there much information on the origins of malnutrition – whether lack of food or chronic enteric infections. Research is also appropriate on the short-term growth deficits (wasting) and the longer-term growth deficits (stunting). An important aspect of the MAL-ED program is to identify markers for malnutrition and enteric diseases.

Dr. Miller explained that healthy gut villi, small finger-like projections that absorb nutrients in the gut (and which, if stretched to make a flat surface, would be almost as large as a tennis court) dramatically change in the presence of enteric disease – there may be bacterial overgrowth, damage to the villi that reduces the surface area and ability to absorb nutrients, and inflammation which may have the same effect. The hypothesis is that continual intake of pathogens, resulting in chronic enteric disease, produces the adverse results already discussed.

MAL-ED was launched to study this problem on three fronts. First, building an infrastructure, a network of research sites, that would focus on identifying the risk factors of malnutrition and enteric disease and their consequences to health. Second, conducting studies that would lead to the ability to quantify the negative consequences of malnutrition and enteric disease. And third, relying on existing data to develop an understanding of the disease burden caused by malnutrition and enteric diseases.

Administered by the Foundation for the NIH, grants are provided to the University of Virginia, Johns Hopkins University, the Jackson Foundation, Christian Medical College, and the Aga Khan University (in Pakistan). The Bill and Melinda Gates Foundation provides significant funding support for the program. All participating institutions have signed on to a research consortium agreement that covers the administrative structure of MAL-ED, data and sample sharing, global access policies, data release and access plans, publications and presentations, and provisions for network and consortium growth.

The study sites were selected on the basis of high incidence of malnutrition and diarrheal disease, and include rural and urban settings. The research protocols are harmonized, and studies will initially look at possible hypotheses and research questions that will take into account social and environmental factors, nutrient uptake, the various types of enteric diseases, and include assessments of growth, anthropometric measures, cognitive development, response to vaccines and gut functions. The sites will collect samples on a continuous basis – blood, urine, fecal samples – that will be stored for future research purposes. Seven technical subcommittees have been established to address surveillance, cognitive development, nutrition/micronutrient assays, gut function, vaccine response, microbiology and data management.

Preliminary data has begun to accumulate and some interesting possibilities are emerging that are comparable among the sites – birth weight profiles, trends in stunting by age, duration of exclusive breastfeeding (which relates to the introduction of pathogens when other foods are introduced in the baby’s diet),

An important project of the MAL-ED cooperative research effort will be models of malnutrition and growth that will contribute to the design of future, more refined research, and a broader understanding of the profile of malnutrition and enteric diseases in the developing world.

During discussion it was noted that the global network for women’s and children’s health research could be integrated in some way with the MAL-ED program. There were also suggestions for specific areas of research that might be appropriate – an assessment of enteric vaccines that are not as effective in the developing world as elsewhere, the efficacy of oral vaccines on immune response (e.g., the rotavirus vaccines); looking at the over- and under-nutrition question (the effect of malnutrition in infancy as a risk factor for obesity in later years).

Dr. Glass commented that a small building near the Stone House, Building 16A, had been closed for years because of deterioration and an asbestos risk related to its original construction. He said that Dr. Elias Zerhouni, near the end of his tenure as NIH Director, provided funding for a proper renovation, with the idea that it could serve as a think tank on campus for all of the ICs. Dr. Glass noted that Nalini Anand had taken the project under her aegis, working to achieve Dr. Zerhouni’s vision.

Ms. Anand announced that Building 16A should open for business within a few months, tentatively scheduled for June 30 with a special opening event on September 12, just before the next Board meeting. She described three essential components of the new facility: 1) that it would be a hub for project-based scholarship in global health science and policy, to provide an opportunity to manage short-term projects of no more than a year with specific goals and objectives, accomplished by multidisciplinary teams; 2) that it would provide a forum for international scientific dialog and collaboration; and 3) that it would be a platform for short-term training in specific areas related to global health.

The project was based on an extensive consultative process, coordinated by Booz Allen Hamilton through the Foundation for the NIH, and included contributions from a wide variety of stakeholders – members of the FIC Board, FIC staff, representatives of many of the NIH ICs, extramural grantees, global health experts from the international research community, and some members of the private sector (foundations, industry, etc.).

A number of common themes came out of the consultative process. Project should represent missions common to a number of institutes and centers, and should focus on challenges common to multiple diseases. The products of these efforts should include new research methodologies and tools. There should be a forum to help NIH understand the research needs, priorities and challenges of the lower and middle income countries, preferably with direct contributions by scientists from those countries.

A multidisciplinary team approach should be used to garner input from within NIH and from the international research community, and the product of the effort should be practical, actionable recommendations that can be accomplished, and not just a report that may languish on a shelf and offer no positive results.

Ms. Anand recognized the valuable advice provided by four Board members, Drs. Yach, Mahmoud, Freire and Pablos-Mendez, who helped formulate the philosophy that projects undertaken at Building 16A should be about specific and manageable issues and challenges, and not “big picture” issues. Secondly, they underlined the importance of understanding conflicts of interest and promoting transparency, and in thinking beyond basic funding to ideas for engaging core competencies and skill sets that are available in the private sector.

Concerning the types of projects that might be appropriate in the early years, Ms. Anand suggested looking at implementation science, developing new evidence-based decision making tools to guide public health strategies and priorities, and creating roadmaps to help define how to approach and solve specific global health problems. An example of the kind of problem that might be addressed is the exploding rate of cancer in China, where a team of both Chinese and NIH modelers could look at the anticipated demographics of cancer in China as the incidence of the disease begins to increase.

Ms. Anand described the physical layout of Building 16A, which would include offices, a conference room, cubicles in which individuals could pursue projects, team work spaces and a combination break room/kitchen. The facility would also offer state-of-the art teleconferencing and videoconference capabilities. She mentioned that many of the envisioned projects would involve sophisticated IT to provide a virtual meeting environment. In education and training, distance learning will be an important part of the new facility.

During the first year, Ms. Anand said that one or two demonstration projects would be undertaken, with the likelihood that one of them would relate to mobile health. It might look at how mHealth could facilitate clinical trials and reduce costs related to those studies. Real time adverse event reporting would eliminate the delays that are currently part of the clinical trial process. Efficient delivery of information could affect behavior (such a program to text pregnant women to increase awareness of health-related issues regarding their babies). And the technology could connect programs in a synergistic way and break down barriers among silos. Electronic connections would bring disparate specialties together to discuss common themes, such as a meeting between HIV/AIDS researchers and researchers in the chronic disease community.

Ms. Anand described short-term training opportunities, such as summer institutes and the creation of “country teams” that could spend some time at the facility contemplating research questions and challenges that would benefit from discussions that could include NIH researchers.

In closing, Ms. Anand invited discussion related to several questions: How can the Center address gaps in global health research and policy? How can the Center promote multidisciplinary and/or multi-sector team science? Implementation – how can the Center insure that products produced are useful and used in the global health community?

Discussion

Mr. Mahmoud commented the Center was a unique venue for bringing together what are now siloed specialties that have difficulty in sharing information and ideas with each other. It could be a platform for discussions that merge science and policy. He offered advice to start small, stay focused, avoid mission creep and develop an agenda that serves the needs of the FIC, and not necessarily the needs of other ICs that may demand high levels of funding. He felt the Center was a facility that could take on new ideas that the specialties, institutions and organizations outside NIH are not able to resolve among themselves.

Dr. Kelley commented that the IOM provides solicited advice with an end product, a consensus report, which is usually quite detailed and lengthy, and takes significant time to produce. That is its branding. Currently the IOM is considering evolving from a think tank to a think-do tank, which involves implementation of new branding. He suggested that the Center must consider the branding it desires and begin at the outset to create that branding. That involves deciding on signature products, the anticipated audiences for the products, the methods of dissemination and the kinds of staff support required to accomplish all of that.

Dr. Kelley commented that an important part of the IOM’s success relies on the permanent professional staff that supports each project. The Center would need to consider staffing, because staffing is the glue that holds the entire project together. Ms. Anand noted that Fogarty has limited resources to devote to the Center, but would provide the core support required to operate at the beginning. She hoped that the staffing philosophy would provide a proof of concept that would inspire others to partner in some of the projects, not only in funding, but in providing temporary personnel and other in kind resources (such a tool kits to achieve certain objectives).

Dr. Guttmacher suggested that Fogarty should carefully consider the scientific vision of the new Center. Since the future of science is considered by many to be interdisciplinary, the Center should define its approach to that issue. For example, one possibility is to encourage “interdisciplinary group sabbaticals.” A small group from a particular region could visit the Center to discuss issues of importance in that region, taking advantage of resources at NIH, including networking opportunities, that would support their discussions.

Related to the branding issue, Dr. Johnson suggested consideration of how the products would be developed. He noted that with a multidisciplinary group, parts of the written product could be prepared independently by the various specialties, and then transformed into a final product by a consensus process in which all participate.

Dr. Yach reiterated the importance of limiting the scope of the projects at the beginning, and of defining the limits of what the Center may offer. In addition, as a federal entity, the center should try to link other agencies that have intellectual capital that could be brought to the table – USAID, USDA, Department of State and so on.

Dr. Yach affirmed that dissemination/implementation is of critical importance, and that might involve including Fogarty’s communications capabilities in the mix. Finally, Dr. Yach felt that an opportunity to create on-campus interest in the Center would be to offer a breakfast lecture on various topics of interest in the global health area, perhaps every week or every other week on a specific day of the week. The opportunity for coffee, Danish and an intellectual experience could bring people into the facility and broaden awareness of its existence.

Dr. Bloom noted that the NIH campus is replete with professional who are qualified to teach short courses on various subjects pertinent to global health. Engaging those individuals also increases awareness of the center’s role. Concerning the international arena, Dr. Bloom suggested that those courses could be taught through the electronic videoconferencing capabilities and possibly reach leadership and staff of the ministries of health in various developing countries. This would serve not only an education goal, but introduce NIH to more individuals in the developing countries.

Dr. Freier reiterated the importance of focus of mission and the development of Center leadership. She added that it would be appropriate to create an early “hit,” something at the beginning of the Center’s existence to establish credibility. The “hit” should be something that would stimulate interest across most, if not all, of the ICs. Dr. Arnand noted that there was already a small group of individuals from the IC’s leadership level that had agreed to provide program recommendations during the first year.

Dr. Black noted that much of the implementation effort in the research community is done on an ad hoc basis, contracts negotiated for individual projects. He felt the Center could encourage a more coordinated implementation process for NIH, as a whole.

Dr. Vermund commented that Fogarty training, as effective as it is, may fail to include a mentorship component. The Center might be able to provide that training element during initial training, or when Fogarty scientists return to NIH for short-term visits. In any case, he felt that mentorship training should be a part of the Fogarty program.

Second, he encouraged a focus on IT to facilitate meetings by teleconference and videoconference. In many cases it would obviate the need to support expensive on-site conferences, and the associated travel, lodging and meals expenses. Third, Dr. Vermund expressed concern that many Fogarty research trainees are pulled into non-research roles, often with NGOs and with government agencies.

Finally, he conceded that, although many Fogarty efforts produce high quality results, there is often a reluctance to pursue proper implementation, sometimes because of funding issues. He felt the Center might play a consultative role to provide bridging to groups that were more comfortable with implementation.

Finally, Dr. Cassell pointed out that Fogarty, through the Center, has the potential to offer courses in various areas of global health, particularly through the IT venue. Concerning funding, she invited consideration of the model of some Washington area advisory boards that accept annual dues payments for organizations that would like the opportunity to submit projects for consideration.

Ms. Puderbaugh began her presentation by expression appreciation to a special advisory group that has been participating in the growth of the FIC communications program: Mary Wooley, president of Research America; Aaron Sherinan, Director of Communications and Public Affairs at the UN Foundation; Jenna Mills, communications manager at the Foundation for the NIH; and John Burkow, communications chief for NIH. She added that Board member Maria Freire would assume a consultative role in the focus meeting on communications after the formal Board meeting, and she will report on the meeting at the next Board meeting.

Ms. Puderbaugh explained that, when she began formulating the communications strategic plan, she reviewed the FIC strategic plan and goals, which included an NCD agenda, a focus on implementation research, the development of human capital in low and middle income developing countries, and a focus on Fogarty partnerships of all kinds.

Describing the communication audience as an expanding circle, she noted that the core audience is Fogarty and NIH staff and Fogarty grantees, followed by the various partners and collaborators in the biomedical community and the private sector that support Fogarty programs. Then on the outer edge of the communications circle there are groups that need information about global health, including advocates, policy makers, media, foreign governments, students and the general public (which in surveys has been shown to be quite interested in and have opinions about U.S. global health policies).

Ms. Puderbaugh demonstrated the importance of a strong Fogarty communications program by pointing out that Fogarty is the smallest of the ICs, but has the greatest number of collaborations across all the ICs.

Commenting on the evolution of what was not a vibrant web site and newsletter product four years earlier, Ms. Puderbaugh noted that then there was no full-time staff involved in the program, most of the work was done by a relatively expensive outside contractor, and both the web site and the newsletter were bland and static instruments. Since then, a dedicated team has been developed, including a full time communications specialist, Jeff Gray; three contractors, including a nearly full-time newsletter editor, Steve Goldstein, a web manager, Ana Ellis and a web designer, Carla Conway, both of whom contribute about 16-18 hours a week; and a summer intern, Andrew Palos.

At about the time of the 40th anniversary, a rebranding of Fogarty International Center was undertaken, including the design of a new logo, and a new face on the newsletter and the web site. A PowerPoint kit was developed for staff making presentations, and a trainer was brought in to work with program officers and senior staff on developing effective presentations. The 40th anniversary also provided an opportunity to do some community outreach, including a joint program with Georgetown University Law School on global health diplomacy.

Ms. Puderbaugh noted that the newsletter was the main product of the communications program. It is on the web, articles are individually linked for ease of forwarding to additional recipients, content has been expanded to include discussion of more trans-NIH global health activities and programs, and there has been a significant expansion of the graphics and images included in the newsletter and on the web site. A professional contractor has been added and photos are accepted from freelance contractors. There is preliminary use of social media, and interest in participating in YouTube (grantees are submitting interesting video clips), as well as Twitter, Facebook, and Flickr.

Ms. Puderbaugh commented that Fogarty is taking advantage of a number of services to expand access to audiences – the EurekAlert news service, sponsored by AAAS, provides distribution to the AAAS audience, and a contract with ForeSee offers a customer survey capability to assess customer satisfaction with both the newsletter and the newly designed web site. Finally, Fogarty is participating in a media distribution service, Govdelivery, that facilitates distribution of releases to other federal agencies. In addition, when an individual subscribes to a federal newsletter, such the State Department’s newsletter, the individual is given an opportunity to click on a subscription icon for the Fogarty newsletter.

The launch of the new web site has been successful, with web traffic up (over half of all visits are by new web users). The site has improved search capabilities so that visitors may search by topic, program, geographic area, etc.

Finally, Ms. Puderbaugh described the effort to provide more substantive stories in the newsletter and on the web site. Examples include the story of a Fogarty grantee who has been working with the Yemeni government to learn more about the insidious khat addiction that is adversely affecting productivity among Yemeni males; and the story of NIH research on health in the Mississippi delta regions that caught the attention of a London Times reporter whose story was picked up by the U.S. wire services and widely published in the U.S press and television. That resulted in awareness at the highest levels of the Departments of State and Health and Human Services, as well as by officials in Iran who offered to collaborate with Fogarty on a similar project in there.

Ms. Puderbaugh ended her presentation with an invitation for comments.

Discussion

Asked about measuring impact of the new web site and newsletter format, Ms. Puderbaugh explained that, although resources were limited for that purpose, staff had collected anecdotal evidence of response, and there was a web survey to which over 400 responses were received. Dr. Glass mentioned that the web site software provides access to statistics about the site – who visits, how long they stay, whether they return, etc. – but that is a crude quantitative measure and not a qualitative analysis. He added that more involvement in the social media should produce information on impact, especially among the younger members of the Fogarty audience.

Dr. Glass asked whether the mission of the web site should be to promote Fogarty or global health. Dr. Guttmacher responded that promoting NIH global health is a path to increasing resources for NIH programs in global health, which also increases resources for Fogarty programs. An objective should be to become the portal through which information is obtained about global health. Dr. Shurin agreed that, with 28 ICs, each of which may have a slightly different branding with regard to global health, there is a difficulty in getting a coherent, unified message across, and that affects Fogarty because of the broad range of collaborations with the ICs. Therefore, developing that portal recognition for Fogarty is an important consideration in communications policy. She added that one important thought is that the ICs typically do not have extensive expertise in global health, and relying on the expertise that Fogarty offers makes global health collaborations more effective.

Dr. Burklow, Director of Communications for NIH, observed that Fogarty is typically seen as an active convener in the area of global health and that educating the granting institutions about Fogarty may be appropriate. But as far as the general public is concerned, the message should focus on the importance of global health and global health research, emphasizing that they should not be considered as “foreign health” or “foreign health research.” The approach should be to explain, through compelling stories, why the U.S. invests in global health. Dr. Burklow added that traditional mass media outlets might not be appropriate now, and that Fogarty’s effort should be directed at defined audiences that demonstrate a reasonable level of interest in the benefits of global health research.

Dr. Glass agreed, pointing to the example of the benefits to the at risk populations in the U.S. of the HIV research in prevention that could only be accomplished in the developing world where the incidence of the disease was sufficient to allow recruitment of a properly powered cohort. That study in the U.S. would never have been economically viable because of the relatively low incidence of the disease.

Dr. Pablos Mendez commented that a page could be taken from those who run campaigns, since there is a science to campaign management that may apply to the communications process around global health. He added that, in terms of developing the compelling stories, there may be an opportunity in syndication. Stories from other sources may be useful to Fogarty without requiring the need to create the story or to reinvent it for the web site or the newsletter.

Dr. Freire expressed the opinion that an important reason to have a good communication plan is to mobilize resources – money, people, credibility – and that what is published should target those who can enhance that mobilization. And the global research agenda can be shared outside the U.S., with other financially able countries such as South Africa, China and India, to increase the potential of commitment of resources.

Dr. Yach asked if there was a plan to evaluate impact on any of the key audiences. He noted that the linkage to the researchers appears to be effective, but it would be helpful to determine the impact especially on the newer grantees and researchers, to establish a baseline of information about awareness among that group. Finally, an important audience is congressional staff, and it would be useful to establish a similar baseline of the level of awareness of the Fogarty and NIH global health programs in that group.

Dr. Yach added an afterthought, that to be a truly effective international organization, communications should begin to include translations into the languages of the key groups that are involved in Fogarty collaborations.

Mr. Sherinian, a member of the communications advisory group, offered several ideas. The reception of the public related to public health stories relies on confidence in the authority of the source, and Fogarty certainly qualifies as such an authority. It also appears to be true that stories are more likely to be accepted when they are written at a level that permits easy understanding, devoid of highly technical descriptions. Finally, the public is more amenable to stories that have outcomes that are attainable in the near future. As an example, he pointed to the issue of indoor air pollution caused by cook stoves, an issue that is easy to grasp and easy to relate to.

Dr. Vermund agreed that simple, understandable communications is important and he recommended relying on case histories that convey human stories, such as the importance of malaria and dengue vaccines for U.S business and military travelers to high risk countries.

Concerning funding, Dr. Shurin noted that, although she might appear at an appropriation committee hearing on the Hill as the director of NHLBI, it is the testimony of advocacy groups at those hearings that really influences the money that is appropriated. Therefore, it is important that those groups be armed with as much information as possible. Those groups must understand that the argument cannot be global health versus domestic health, but that global health research is important in finding answers to scientific questions important to domestic health that can only be answered in the developing world environment, such as the conduct of the HIV/AIDS study. Dr. Bloom agreed that pushing information into the public sector is important, but that even more important may be the creation of demand, which should be an integral part of every IC’s communications plan.

Dr. Shurin added that another part of the message is that healthier societies result in stronger economies and increased political stability. Countries financially able to support health research, like China, and India, should be encouraged to contribute, and that involves collaborations in capacity building, such as those fostered by Fogarty.

Closing Remarks and Adjournment

Dr. Roger Glass

Dr. Glass expressed appreciation for the attendance and the contribution of the members of the Board and the participation of the ex officio members, and for the exceptional efforts of staff that provide the grist for the discussion that takes place during the meeting. He invited anyone interested to visit the Stone House between July 5th and 15th, when the orientation for new fellows and scholars would take occur. It would be an excellent opportunity to meet them.